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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201156
Report Date: 06/22/2022
Date Signed: 06/22/2022 09:17:08 AM


Document Has Been Signed on 06/22/2022 09:17 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:FAIRWINDS - WOODWARD PARKFACILITY NUMBER:
107201156
ADMINISTRATOR:VALERO, DESIREEFACILITY TYPE:
740
ADDRESS:9525 N FT WASHINGTON RDTELEPHONE:
(559) 434-6444
CITY:FRESNOSTATE: CAZIP CODE:
93730
CAPACITY:270CENSUS: 203DATE:
06/22/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:34 AM
MET WITH:Desiree Valero, AdministratorTIME COMPLETED:
09:15 AM
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On 6/22/22 at 8:34 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a POC visit. LPA checked in at front desk and met with Administrator (ADM) Desiree Valero. LPA explained reason for inspection.

Deficiency was issued on 6/2/22 for violation of CCR 87211(a)(1)(D). Plan of correction was due on 6/16/22. As of today, 6/22/22, CCL has not received the Plan of correction as created and agreed upon on 6/2/22. Administrator admits the Plan of correction had not been completed or submitted to CCL.

Civil penalties are being assessed for failure to correct CCR 87211(a)(1)(D) for the period of 6/17/22 through 6/22/22 (6 days) in the amount of $100 per day per citation, for a total of $600. A civil penalty of $100 per day per citation will continue until deficiency is corrected. See form LIC421FC for more detail.

Exit interview was conducted. A copy of this report and appeal rights were given to Administrator Desiree Valero, whose signature confirms receipt of this report.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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